| List of Figures | p. xiii |
| List of Tables | p. xv |
| Preface | p. xvii |
| Contributing Authors | p. xix |
| Etiology of Pituitary Tumours | p. 1 |
| Introduction | p. 1 |
| Pituitary Tumor Initiation | p. 1 |
| Tumor models | p. 2 |
| Oncogene Activation | p. 4 |
| Pituitary Tumor Transforming Gene (PTTG) | p. 4 |
| Activating gsp mutations | p. 7 |
| Activated cAMP-response element binding proteins (CREB) | p. 8 |
| Protein Kinase A and C | p. 8 |
| Ras oncogenes | p. 9 |
| Cyclin Dl | p. 9 |
| Tumor Suppressor Genes | p. 9 |
| Retinoblastoma (Rb) | p. 9 |
| Cyclin-Dependent Kinase Inhibitors | p. 10 |
| P16 / CDKN2A | p. 10 |
| P27 | p. 11 |
| Growth Factors | p. 11 |
| Fibroblast Growth Factors (FGF's) | p. 11 |
| FGF-2 (Basic FGF) | p. 11 |
| FGF-4 | p. 12 |
| Vascular Endothelial derived Growth Factor (VEGF) | p. 12 |
| Transforming Growth Factors (TGF's) | p. 12 |
| TGF-[beta] | p. 12 |
| TGF-[alpha] | p. 13 |
| Angiogenesis | p. 13 |
| Hypothalamic Factors and Their Receptors | p. 14 |
| GHRH and Somatostatin | p. 14 |
| Corticotrophin releasing hormone (CRH) | p. 14 |
| Thyrotrophin Releasing Hormone (TRH) | p. 15 |
| Gonadotrophin Releasing Hormone (GnRH) | p. 15 |
| Hereditary Syndromes | p. 15 |
| Multiple endocrine neoplasia | p. 15 |
| Carney Complex | p. 16 |
| McCune-Albright syndrome | p. 16 |
| Familial acromegaly | p. 16 |
| Estrogen and Estrogen Receptor | p. 17 |
| Transcription Factors | p. 17 |
| Pathology of the Pituitary | p. 33 |
| Introduction | p. 33 |
| Normal Anterior Pituitary | p. 34 |
| Anterior pituitary development and cytodifferentiation | p. 35 |
| Neuropeptides, growth factors and cytokines | p. 36 |
| Pituitary Adenomas | p. 37 |
| Classification | p. 37 |
| Growth hormone secreting tumours | p. 39 |
| Prolactin secreting adenomas | p. 40 |
| TSH secreting adenomas | p. 41 |
| Corticotroph adenomas | p. 41 |
| Gonadotroph adenomas | p. 42 |
| Plurihormonal adenomas | p. 42 |
| Non-functioning/silent adenomas | p. 42 |
| Other investigations | p. 43 |
| General immunohistochemistry | p. 43 |
| Pituitary hyperplasia | p. 43 |
| Other tumours | p. 44 |
| Imaging the Pituitary | p. 51 |
| Imaging Techniques and Normal Anatomy | p. 51 |
| Pathology | p. 54 |
| Congenital | p. 54 |
| Pituitary Tumours | p. 56 |
| Adenoma | p. 56 |
| Craniopharyngioma | p. 66 |
| Meningioma | p. 66 |
| Other Tumours | p. 66 |
| Non-Functioning Pituitary Tumours | p. 75 |
| Introduction | p. 75 |
| Definition of Non-Functioning Tumours (NFA) | p. 76 |
| Histological classification of non-functioning tumour | p. 76 |
| Cytogenesis of NFA's | p. 78 |
| Incidence and prevalence of pituitary tumours | p. 79 |
| Presentation and Evaluation of NFA | p. 81 |
| Management of NFA's - Surgery and Radiotherapy | p. 83 |
| What Should Be the Policy for Use of Rt for NFA's? | p. 86 |
| Hypopituitarism is associated with increased mortality | p. 86 |
| Prolactinoma | p. 95 |
| Introduction | p. 95 |
| Production and Effects of Prolactin | p. 95 |
| Presentation | p. 97 |
| Endocrine Effects | p. 97 |
| Mass Effects of Pituitary Lesion | p. 97 |
| Diagnosis | p. 98 |
| Biochemical Evaluation | p. 98 |
| Radiological Evaluation | p. 99 |
| Treatment | p. 100 |
| Why Treat? | p. 100 |
| Dopamine Agonists | p. 101 |
| Bromocriptine | p. 101 |
| Cabergoline | p. 101 |
| Quinagolide | p. 102 |
| Pituitary Surgery | p. 103 |
| Radiotherapy | p. 104 |
| Monitoring Treatment | p. 104 |
| Macroprolactinomas | p. 105 |
| Macroadenomas with Moderate Prolactin Excess | p. 105 |
| Microadenomas with Minimal Hyperprolactinaemia: No treatment? | p. 105 |
| Pregnancy | p. 105 |
| Hormone Replacement and Menopause | p. 106 |
| Resolution of Disease and Cessation of Treatment | p. 107 |
| Acromegaly | p. 113 |
| Introduction | p. 113 |
| Clinical Features of Acromegaly | p. 113 |
| Effects on the cardiorespiratory system | p. 114 |
| Acromegaly and cancer risk | p. 115 |
| Diagnosis of Acromegaly | p. 116 |
| Approach to diagnosis | p. 119 |
| Treatment of Acromegaly | p. 119 |
| Cure and remission of disease in acromegaly | p. 119 |
| Mortality and disease control | p. 120 |
| Treatment goals for acromegaly | p. 121 |
| Approach to treatment | p. 121 |
| Surgery | p. 121 |
| Radiotherapy | p. 121 |
| Medical Treatment | p. 122 |
| Dopamine (D2) receptor agonists | p. 122 |
| Somatostatin analogues | p. 122 |
| GH receptor antagonists | p. 123 |
| Summary | p. 124 |
| Cushing's Disease | p. 127 |
| Clinical History | p. 127 |
| Minnie G | p. 127 |
| Clinical Features | p. 128 |
| Infections in Cushing's syndrome | p. 131 |
| Vascular complications | p. 132 |
| Sexual Dysfunction | p. 132 |
| Psychiatric Manifestations | p. 132 |
| Childhood Cushing's Syndrome | p. 132 |
| Intermittent, Periodic and Cyclical Cushing's Syndrome | p. 133 |
| Alternative Diagnoses to Cushing's Syndrome | p. 134 |
| Biochemical Diagnosis of Cushing's Syndrome | p. 135 |
| Serum cortisol | p. 136 |
| Salivary cortisol | p. 136 |
| Urinary cortisol | p. 136 |
| Low dose dexamethasone suppression test | p. 136 |
| Single-dose dexamethasone suppression test | p. 137 |
| Other methods | p. 137 |
| Differential Diagnosis of Cushing's Syndrome | p. 137 |
| Therapeutic Intervention and Follow-Up of Cushing's Disease | p. 145 |
| Pituitary surgery | p. 145 |
| Methods to Determine Whether Pituitary Surgery Has Been Curative | p. 146 |
| Clinical assessment | p. 146 |
| Unmeasurable early serum cortisol | p. 146 |
| Serum or urinary cortisol | p. 147 |
| Pituitary irradiation | p. 148 |
| Bilateral adrenalectomy | p. 149 |
| Choice of Therapy | p. 150 |
| Drug therapy | p. 150 |
| Nelson's Syndrome | p. 151 |
| Conclusions on therapy and follow-up | p. 152 |
| Summary | p. 152 |
| Thyrotropin-Secreting Pituitary Adenomas | p. 167 |
| Introduction | p. 167 |
| Occurrence | p. 168 |
| Pathology and Molecular Aspects | p. 168 |
| Clinical Manifestations | p. 171 |
| Laboratory and Biochemical Findings | p. 172 |
| Serum thyroid hormone and TSH levels | p. 172 |
| Pitfalls in thyroid hormone and TSH determinations | p. 173 |
| Other useful biochemical parameters | p. 174 |
| Dynamic Testing | p. 175 |
| Imaging Studies and Localization of the Tumor | p. 175 |
| Differential Diagnosis | p. 176 |
| Treatment and Outcome | p. 177 |
| Criteria of Cure and Follow-Up | p. 179 |
| Craniopharyngioma | p. 185 |
| Introduction | p. 185 |
| Pathology | p. 185 |
| Adamantinous craniopharyngioma | p. 186 |
| Papillary craniopharyngioma | p. 188 |
| Epidemiology | p. 188 |
| Aetiology | p. 189 |
| Diagnosis | p. 189 |
| Radiology | p. 191 |
| Differential diagnosis | p. 191 |
| Treatment of Primary Craniopharyngioma | p. 191 |
| Surgery | p. 192 |
| Adjuvant radiotherapy | p. 192 |
| Radiosurgery | p. 193 |
| Intracystic brachytherapy | p. 194 |
| Intracystic bleomycin | p. 194 |
| Treatment Outcomes in Craniopharyngioma | p. 194 |
| Overall standard outcome data | p. 195 |
| Surgery: gross total excision or sub-total resection? | p. 195 |
| Adjuvant radiotherapy | p. 196 |
| Endocrine outcomes of craniopharyngioma | p. 196 |
| The Management of Recurrent Disease | p. 197 |
| Monitoring of recurrent disease | p. 198 |
| Surgery for recurrent disease | p. 198 |
| Adjuvant radiotherapy and radiosurgery in recurrent disease | p. 198 |
| Options for recurrent cystic disease: drainage or intracystic therapy | p. 199 |
| Systemic treatments for recurrent and resistant disease: cytotoxic and immunomodulatory therapy | p. 199 |
| An Integrated Approach to the Management of Craniopharyngioma | p. 201 |
| Pituitary Incidentaloma | p. 207 |
| Introduction | p. 207 |
| Types of Pituitary Mass Lesions | p. 207 |
| Autopsy Findings | p. 208 |
| Ct and Mri Scans in Normal Individuals | p. 210 |
| Diagnostic Evaluation | p. 211 |
| Endocrinologic Evaluation | p. 211 |
| Radiologic Evaluation | p. 213 |
| Recommendations | p. 214 |
| Summary | p. 215 |
| Pituitary Surgery | p. 221 |
| History of Pituitary Surgery | p. 221 |
| Aims | p. 221 |
| Techniques of Surgery | p. 222 |
| Preparation for Operation | p. 222 |
| Risks of Surgery | p. 223 |
| Technical Aspects of Surgery | p. 223 |
| Transcranial Surgery-Technical Aspects | p. 224 |
| Results of Pituitary Surgery | p. 225 |
| Non Functioning Adenoma | p. 225 |
| Acromegaly | p. 225 |
| Cushing's Disease | p. 225 |
| Prolactinomas | p. 226 |
| Pituitary Apoplexy | p. 226 |
| Pituitary Re-Exploration | p. 226 |
| Complications of Transphenoidal Surgery | p. 226 |
| Nasal Complications | p. 227 |
| Impaired Pituitary Function | p. 227 |
| CSF Leakage | p. 227 |
| Visual Deterioration | p. 227 |
| Meningitis | p. 227 |
| Syndrome of Inappropriate Anti-diuretic Hormone Release (SIADH) | p. 228 |
| Complications of Transfrontal Surgery | p. 228 |
| Frontal Lobe Damage | p. 228 |
| Optic Nerve Damage | p. 228 |
| Vascular Damage | p. 228 |
| Hypothalamic Damage | p. 228 |
| Surgical Experience | p. 229 |
| Future | p. 230 |
| Radiotherapy for Pituitary Tumours | p. 233 |
| Testing of Hypothalamo-Pituitary Axis | p. 247 |
| Introduction | p. 247 |
| Prolactinoma | p. 248 |
| Acromegaly | p. 248 |
| Cushing's Syndrome | p. 249 |
| TSH-Secreting Pituitary Adenoma | p. 250 |
| Nonfunctioning Pituitary Adenoma | p. 251 |
| Diabetes Insipidus | p. 251 |
| GH Deficiency in Adults | p. 252 |
| ACTH Deficiency | p. 253 |
| Hypothyroidism | p. 254 |
| Hypogonadism | p. 255 |
| Hypothalamic-Pituitary Axis Testing | p. 256 |
| Oral glucose tolerance test (OGTT) | p. 256 |
| TRH stimulation test | p. 256 |
| GnRH stimulation test | p. 257 |
| GHRH stimulation test | p. 257 |
| Arginine stimulation test | p. 257 |
| Low dose DST | p. 258 |
| Standard high-dose DST | p. 258 |
| Metyrapone test | p. 258 |
| CRH stimulation test | p. 259 |
| ACTH stimulation test | p. 259 |
| Insulin tolerance test (ITT) | p. 259 |
| Clomiphene stimulation test | p. 260 |
| Fluid deprivation/DDAVP test | p. 260 |
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